title: Liver resection with concomitant inferior vena cava resection: experiences without veno-venous bypass.
abstract: OBJECTIVE
  Liver resection offers the chance of a cure for liver cancer. However, when extended hepatectomies were performed in combination with resection of the inferior vena cava (IVC), the procedures were reported to have a surgical mortality rate in excess of 5 %. While most of these operations were performed with the use of veno-venous bypass, this study presents our experience performing the procedure without the bypass.
  
  
  METHODS
  Data were collected from a prospectively maintained database. A retrospective evaluation of a consecutive series of concomitant IVC and liver resections was performed.
  
  
  RESULTS
  Five hundred and seventy-five liver resections were performed between June 2008 and November 2011. Eleven patients (1.9 %) underwent concomitant IVC and liver resections. One patient required segmental IVC replacement, and four IVC defects were closed using a bovine pericardial patch without bypass. Only one patient had histologically confirmed IVC invasion. There was no postoperative mortality. Nine postoperative complications occurred in five patients. No complications in terms of IVC patency were seen. Five patients had disease recurrence, one of whom died within 12 months of surgery.
  
  
  CONCLUSIONS
  Concomitant liver and IVC resection is safe without using a bypass procedure, with acceptable short-term results. Meticulous technique, careful patient selection and a specialized anesthetic team are key to obtaining low postoperative morbidity and mortality rates and an acceptable oncological outcome.
authors.affiliation: Department of General and Hepatobiliary Surgery, University Hospital Aintree, Longmoore Lane, Liverpool, L9 7AL, UK, s.staettner@salk.at.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stättner
authors.forename: Vincent
authors.initials: V
authors.lastname: Yip
authors.forename: Robert P
authors.initials: RP
authors.lastname: Jones
authors.forename: Carmen
authors.initials: C
authors.lastname: Lacasia
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Hassan
authors.initials: H
authors.lastname: Malik
mesh_terms: D000328:Adult; D019917:Blood Vessel Prosthesis Implantation; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012196:Review Literature as Topic; D013997:Time Factors; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*